Provider Demographics
NPI:1316707177
Name:CAROLLA, BETH (RN)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:CAROLLA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 BRADDOCK DR
Mailing Address - Street 2:
Mailing Address - City:OHIOPYLE
Mailing Address - State:PA
Mailing Address - Zip Code:15470-1322
Mailing Address - Country:US
Mailing Address - Phone:724-984-3286
Mailing Address - Fax:
Practice Address - Street 1:30 MON GENERAL DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2853
Practice Address - Country:US
Practice Address - Phone:304-285-2720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV118956163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse